Pips Tomkinson and Liz Doxford-Hook

Pips F1 in SJUH in General Medicine/Urology/Upper GI F2 in Huddersfield in A+E, T&O, Respiratory

Liz F1 in SJUH in General Medicine/Colo-rectal/Psych F2 in Harrogate in O&G, T&O and GP

Pips sports medicine

Liz obs and gobs

Introduction Cases

Summary

This is a communication station Mr Spence is an inpatient on J45. He is being treated with gentamicin for pyelonephritis. The night team miscalculated the dose and gave him 560mg instead of 400mg. Please discuss this error with the patient.

Introduce, check ID, wash hands, relative Open introduction to problem Let them vent anger and validate their feeling Non-verbal ACTION Complaints procedure Their care will NOT be affected SCALF

This is a counselling station This 62 year old woman has had a PE whilst in hospital. She will need a 6 month prescription of Warfarin. Please can you counsel her on Warfarin.

Use your counselling OSCE station template

1. 2. 3. 4. 5. 6. Introduce Explain why they need it Their current understanding of warfarin Explain at patients level Check understanding/summarise Any questions?

Lots of points to cover:

1. 2. 3. 4. 5. 6.

Suitability What is it/what does it do How to take it Side effects Precautions Regular blood tests

Suitability
a. b. c. d. e. f. What other medication are you on Have you ever had a stroke Do you suffer with stomach ulcers Are you pregnant Recent operation Hypertension

Explanation
a. b. c. d. Warfarin thins the blood Less likely to clot Need to prevent further clots Explain INR

How to take it
a. Take instructed dose everyday b. Same time each day c. If you miss a dose, do not double dose. Tell you GP straight away d. Do not stop warfarin suddenly, seek advice first

Side Effects
a. b. c. d. Bleeding!!!!!!!!! N&V Jaundice Skin Rashes

Precautions
a. b. c. d. e. Trauma!!!! Alcohol intake Diet Pregnancy (1st trimester) Drugs interactions

This is a management station. You are the FY1 covering the surgical unit at night. Mr L came in with an acute GI bleed, the initial management for this has been done and he is now stable. You chase his blood like the diligent F1 you are and notice:
Result
K+ - 5.0 Na+ - 138 Cr 296

Normal Value
3.5 - 5 135-145 60 110

Admission bloods
4.2 134 98

Ur 29.5

2.5 6.7

20

Losartan 50mg OD Aspirin 75 mg OD Clopidogrel 75mg OD Bisoprolol 5mg OD Metformin 1g TDS Gliclazide 160mg OM and 80mg dinner MST 30mg BD Paracetemol 1g QDS Simvastatin 40mg ON Tinzaparin 4,500 units SC Folic Acid 5mg TDS Vitamin B Co-strong 2 tablets TDS

Losartan 50mg OD Aspirin 75 mg OD Clopidogrel 75mg OD Bisoprolol 5mg OD Metformin 1g TDS Gliclazide 160mg OM and 80mg dinner MST 30mg BD Paracetemol 1g QDS Simvastatin 40mg ON Tinzaparin 4,500 units SC Folic Acid 5mg TDS Vitamin B Co-strong 2 tablets TDS

Advice: Dont panic. Know the emergency conditions like the back of your hand Dont wear a short skirt/low top (boys) If you come across something that you dont know breathe, take a minute, re-read and the examiner will guide you (everyone will be thinking the same)